Medical students tend to hold negative stereotypes about depression when they suffer from the disorder themselves. Why? The high-pressure, cutthroat environment of medical school may be to blame.

The study, published Tuesday in the Journal of the American Medical Association, found that medical students who had moderate to severe symptoms of depression were more than twice as likely as those with few to no depressive symptoms to believe that their student colleagues would have less respect for their medical opinions if they knew that they’d been diagnosed with depression.

“We now better understand, in more specific detail, the way that depressed students experience their medical education and it causes us to worry about the atmosphere of [medical school], and how we make students feel like they have to be perfect and not be vulnerable,” says lead author Dr. Thomas Schwenk, professor and chair of family medicine at the University of Michigan, Ann Arbor.

Although a great deal of attention has been given to overtreatment and overmedication for depression, the new study found that most of the medical students whose symptoms would qualify them for a diagnosis of depression had not previously been diagnosed with or treated for the disorder.

Confirming findings in the general population, the study also found that female medical students were twice as likely to have severe depression symptoms, compared with males. But while women in general are less likely to commit suicide than men, in doctors the pattern was turned on its head: female doctors were three times more likely to commit suicide compared with other women, while male doctors had only a 50% elevation in suicide rate compare with other men. About 300 to 400 doctors commit suicide each year, says Schwenk.

Of course, part of the problem is that doctors notoriously ignore their own physical and mental disorders. “We tend to deny a lot,” says Schwenk. “We tend to think that the normal rules of life don’t apply to us. That may be good in certain situations but doctors are people, too. We really need to teach them how to take better care of themselves so that they can continue to take better care of others.”

The increase in cases of depression, especially in students, impacts the whole nation. Neurologists of Long Island have been more active to find the best treatment for depression. After several trails they have come to the conclusion that TMS therapy is the best treatment for depression.